I'm considering various procedures to eliminate thin, sagging skin that I'm starting to under my eyes. I had heard that lower blepharoplasty left no visible scars - that the scar is inside the lower eyelid. However, everyone having gone through it here says they now have visible scars. Can someone shed some light on this? Thanks in advance! - michelle
Visible Scars from Lower Blepharoplasty?
Doctor Answers 13
Lower eyelid blepoharoplasty: the incision options
You are discussing two different approaches to the lower eyelid:
- The transconjuntival approach: the incision is made on the inside lining of the eyelid across the conjunctiva hence the name transconjunctival approach. This is used to remove or rearrange the fat but does not treat the skin. Therefore, it tends to be performed in young individuals or those with minimal skin excess or muscle redundancy.
- The subciliary approach: the incision is usually placed immediately below the lower eyelid lash line. It tends to heal well with subtle scarring. It is very useful and many surgeries can be accomplished through this approach to treat problems of the skin, fat, muscle or bone. In addition to the lower lid, midface lifts and cheek implants are possible.
Depending on your anatomy and desired treatment goals, your surgeon will discuss if you are a candidate for either procedure.
I hope this helps.
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Loose skin under the eyes
Loose skin under the eyes is a difficult problem.
A transconjunctival blepharoplasty (removal of the fat from the inside of the eye) can actually make the loose skin worse. A TCA or laser peel often helps somewhat but is typically not powerful enough to tighten the skin significantly.
Incisions below the eye (subciliary incision) leave scars that can be visible and in fact are visible in almost all patients, if you look closely enough. Also, removal of skin from below the eye can alter eye shape by pulling down on the eyelid, chaning or rounding the eyelid shape.
Many patients in our practice benefit from a limited cheeklift with an ultrashort incision (USIC), an incision that does not go completely across the lower eyelid but is confined to the lateral portion of the cheek. This accomplishes elevation of the cheekpad (usually also a problem with the aging eye), reduction in the apparent eye-cheek junction (the stepoff between the lower eyelid and the upper part of the cheek), as well as safer tightening of lower eyelid skin than removal of skin alone, or removal of skin with a canthopexy, which can result in a cat-eye appearance when the corner of the eye severely turns upward but the center of the eyelid is rounded downward.
At some point we recognize as surgeons that we cannot fully correct all deformities completely, at least not without causing considerable surgical artifact. So good judgment, conservative thinking and an interest in the midface are recommended when selecting your lower eyelid/cheeklift surgeon.
Lower lid scars
The lower lid rejuvenation process can be addressed by a trans-cutaneous approach, which is the route that places the incision just beneath the lashes. The other route is the transconjunctival approach which simply removes the fat from the inside of the lower lid with out any visible skin incisions. The transcunjunctival is not for every one and most times requires some level of skin tightening. This can be in the form of laser skin tightening or just a pinch excision. In general the incision under the eyelashes should be a fine one with a nearly invisible characteristics.
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Lower blepharoplasty may result in barely visible scars
Lower eyelid blepharoplasty can be performed in a number of ways. Some approaches allow for an incision through the inside of the lower eyelid. In this situation, no visible scarring will be seen.
Other approaches, however, require an incision through the skin just beneath the lower lashes. In this situation, a visible scar will be present. This scar however tends to be barely perceptible and easily camouflaged with normal eyeliner. The type of procedure most appropriate, depends upon the type of eyelid deformity one has.
If the problem is one of excess fat in the lower eyelid without excess skin, then a trans-conjuctival approach through the inside of the lower eyelid will be appropriate.
If, however, one has a significant amount of excess skin in addition to excess fat, then a more traditional transcutaneous approach through the skin beneath eyelid lashes will be more appropriate. This will allow for removal of both fat as well as excess skin. Although this approach does result in a visible scar, it is rare that the scar is of any clinical significance.
For most patients, it is difficult to see the scar in as little as two or three months their surgery. Your doctor should be able to advise you as to the most appropriate approach for your situation.
Scars after blepharoplasty
In order to address both contour and skin excess of the lower lids, an incision is placed right below the lash line. Because the skin is very thin here, this line heals up very well without leaving aesthetic issues.
Inside the eye incisions for a transconjunctival eyelid lift sometimes leads to additional skin laxity. In order to prevent this, some surgeon like laser resurfacing in combination with this technique. If you have significant skin laxity to begin with, this may not be enough, though.
Scars and lower lid blepharoplasty
Thanks for your question -
You're describing two different approaches for blepharoplasty - One is subciliary (meaning below the eyelash) and the other is transconjunctival (through the conjunctiva at the inside of the lid).
The transconjuntival approach only addresses the contents of the tear trough area. It cannot correct excess skin. This technique can be used with other techniqes (such as laser) to tighten the skin and avoid scars.
I hope this helps.
Subciliary for skin removal
If you have sagging skin you will need a small incision under the eye lashes. This incision usually heals very well and leaves behind a very thin scar that is hard to see.
The transconjuctival incison allows removal or redraping of excess fat pockets. It does not allow removal of excess skin.
If you have extra skin you will have a scar
It's true that lower lid blepharoplasties can be done in many different ways. The transconjunctival or incision inside the lower lid is used when only fat removal or fat redraping is needed.
However, if any skin needs to be removed or if the lid needs tightening than a skin incision is made. This incision is just under the eyelashes and extends into the lateral crease a few millimeters. The scar is very imperceptible when healed.
See several Board Certified Plastic Surgeons to find the one you're most comfortable with.
Not likely a good candidate for transconjunctival bleplaroplasty
There are very few patients who are great candidates for only a transconjunctival blepharoplasty. This procedure either removes bulging fat from the inside of the eyelid or at times allows for repositioning of the fat. Only younger patients are usually good candidates for the procedure. It would not be the procedure of choice for thin eyelid skin. An external lower eyelid incision, when placed in the appropriate position will blend in to the natural lines of the face and be barely noticeable.
You can have transconjunctival blepharoplasty
A transconjunctival incision is an incision that is made inside the lower eyelid that avoids an external incision. The best candidates for this are people that don't need to remove skin and just need fat that is bulging taken out. If you are looking to remove extra skin as well, an external incision is unavoidable in a lower blepharoplasty.
The other option is filling up the area under the eye with a filler or fat injections. Fat injections last much longer than commercially prepared fillers. There is more involved but it is worth it. You can check out my website for some results. Filling the lower eyelid and cheek with fat can be the best way to make someone look younger in the lower eyelid and cheek areas.